Ob-Gyn Coding Alert

Question: My doctor did a diagnostic laparoscopy (49320), a hysteroscopy (58555), a dilation and curettage (58120), and a NovaSure with endometrial ablation (58563). What codes I can bill for this date of service?

Connecticut Subscriber

Answer: First of all, you must have a medical indication for the diagnostic laparoscopy (49320, Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washings [separate procedure]). Some physicians are now doing the laparoscopy to ensure they do not puncture the uterus during the hysteroscopic procedure. If that's the reason, most payers will not reimburse it.

Second, you have an all inclusive code that includes hysteroscopy with a dilation and curettage (D&C): 58558 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C). Notice the phrase "with or without D&C."

Warning: Trying to bill separately for the hysteroscopy as 58555 (Hysteroscopy, diagnostic  [separate procedure]) and the D&C as 58120 (Dilationand curettage, diagnostic and/or therapeutic [nonobstetrical]) is unbundling.

Now look at the NovaSure with endometrial ablation procedure (58563, Hysteroscopy, surgical; with endometrial ablation [e.g., endometrial resection, electrosurgical ablation, thermoablation]). You cannot bill the D&C in addition. Rationale: This is because both procedures are removing the lining of the uterus, and payers will allow you to bill for only one method. Bottom line: You potentially can bill 49320 (as long as you have a medical indication) and 58563. You should list the highest valued procedure first. That means you'd list 58563 with 48.44 relative value units (RVUs) ahead of 49320 with 8.29 RVUs if you are performing the NovaSure/laparoscopy in your office setting. In the inpatient setting, 58563 will still be listed first, but carries only 9.21 RVUs in the facility setting.